Provider Demographics
NPI:1497757173
Name:AMRIEN, JOHN R (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:AMRIEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4 BYPASS RD STE 201
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NJ
Mailing Address - Zip Code:08079-2053
Mailing Address - Country:US
Mailing Address - Phone:856-935-0066
Mailing Address - Fax:856-935-7247
Practice Address - Street 1:4 BYPASS ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:SALEM
Practice Address - State:NJ
Practice Address - Zip Code:08079
Practice Address - Country:US
Practice Address - Phone:856-935-0066
Practice Address - Fax:856-935-7247
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA04675700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC56580Medicare UPIN
NJ510951Medicare ID - Type Unspecified